MEDICARE: TRAVELING GRACE HOME HEALTH AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1811621642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVELING GRACE HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	2357 WARM SPRINGS RD STE 138
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 WARM SPRINGS RD STE 138
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5692
Country	:	US
Telephone Number	:	334-540-9191
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MELTRESIA SANDERS
Credential	:
Telephone Number	:	334-540-9191

Provider Enumeration Date	:	07/16/2022
Last Update Date	:	09/13/2023

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